Version 2017Q1 Quest Cloud Services NYSDOH Network ... · Quest Cloud Services ... that full submissions for all issuers and all products does not begin until mid-2017. 2 ... Required:

Quest Analytics, L.L.C. 4321 W. College Ave, Suite 300

Appleton, Wisconsin 54914 Office 920.739.4552

Fax 920.739.4902

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Version 2017Q1

Quest Cloud Services – NYSDOH Network Management Suite™ – Quick Reference Guide

Welcome to the Quest Analytics Quest Cloud Services – Network Management Suite™. To streamline your experience, this quick reference guide should help you navigate through the features and capabilities. The Quest Cloud Services™ requires more current browsers; therefore, we recommend I.E. 10 or above or Google Chrome. From the Deficiency Tracker in the Provider Network Data System (PNDS) portal, you will have an option to View Report, this will bring you to the Quest Cloud Services™.

Once in the Quest Cloud Services™, you will select from the two dropdowns below: First, the submission schedule you want to review, and second the product you want to review. Please note that full submissions for all issuers and all products does not begin until mid-2017.

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Network Adequacy – there are various views to monitor the status of the issuer networks.

Executive Summary - allows for the review of the overall status of the network. This is represented by a donut chart. A network meeting all requirements is represented by an all green circle. The donut charts are visual aids created by Quest Analytics and are not used by the Department of Health/Department of Financial Services in compiling final network adequacy reports.

View Details by County – this view provides the ability to review how each county is performing. A county meeting all requirements is reflected with a full green bar line. Tip – the Status column indicates if the county is active or pending for your service area.

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To drill into the specifics of any county, simply click on the county name. This provides the specialty details to pinpoint any potential deficiencies.

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In County Provider Requirements:

Required: This is the minimum in-county provider count requirement as set forth by the State of New York Department of Health (NYSDOH)/New York State Department of Financial Services (NYSDFS).

Servicing: This is the unique number of providers in the county, based on NPI, in the issuer’s network.

Market: This is the unique number of providers in the county, based on NPI of ALL issuer submitted data for this product.

% of Market: The calculation of servicing divided by market.

Met: Does the minimum-in county provider requirement exceed the required (Y/N).

Surrounding Area Provider Requirements:

Required: Only if the in-county provider requirement is not achievable based on all issuers’ aggregate data per product, will NYSDOH/NYSDFS consider provider counts outside of the county. If providers outside of the county will be considered, it will be noted with an asterisk (*).

Servicing: This is the unique number of providers, based on NPI, in the surrounding area and within the time or distance requirement in the issuer’s network.

Market: This is the unique number of providers, based on NPI, in the surrounding area and within the time or distance requirement based on ALL issuer submitted data for this product.

% of Market: The calculation of servicing divided by market.

Met: Only when an * is in the Required column, is the minimum surrounding area provider requirement met.

Access Requirements: Note: Access requirements are presented as an additional metric for network review, but are not used by NYSDOH or NYSDFS in determining network gaps, and are not used in compiling final network adequacy report.

With %: This is the % of population who have access to a provider/facility within the time or distance requirement.

Without %: This is the % of population who do not have access to a provider/facility within the time or distance requirement.

Market %: This is the attainable % with access based on ALL issuer submitted data for this product.

Met: If 90% or more of the population have access to a provider/facility within the time or distance requirement.

(See Appendix A: Population Distribution Methodology for further explanation on the Access Requirement calculations).

Overall:

Met: If the issuer has met the minimum required in-county provider count or only when the in-county provider requirement is not achievable based on all issuer’s aggregate data per product, a met could be achieved with surrounding county providers.

Note: If you would like to review the entire results, including areas that met minimum requirements, you can change the filter from the default view of Gaps to All. Areas that meet requirements will be color coded in Green.

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Your initial view will only pull back the potential deficiencies. There are 3 color coded deficiency possibilities. Yellow: Failed to meet minimum provider thresholds but passed access requirement (equal to or greater than 90% of the population have access to a provider/facility within the time or distance requirement). Red: Failed to meet minimum provider thresholds and failed to meet access requirements (less than 90% of the population have access to a provider/facility within the time or distance requirement). Gray: No gap potential deficiency; failed to meet minimum provider thresholds and the market (all issuers’ aggregate data per product) fails to meet minimum provider thresholds. View Network Providers and Market Providers:

Network Providers: Providers Submitted by the Issuer for this product. Market Providers (participating in this product): Providers Submitted by ANY issuer for this product. Market Providers (participating in other products): Providers Submitted by ANY issuer across ALL products in the submission cycle. Under each of the above headings, you can apply the following filters:

In-County Providers: Listing of providers within the county only.

Adjacent County Providers: Listing of providers in adjacent counties that are within the time or distance requirement for the population and MAY help meet access requirements.

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Other Providers: In rare situations, there could be providers in non-adjacent counties that are within the time or distance requirement for the population. These providers will be listed here and MAY help meet access standards.

Note: You are able to download the list of network providers or market providers.

If you go back to the view below, you will notice a secondary option to View Details by Specialty:

View Details by Specialty – this view provides the ability to review at a glance how many counties in your service area have gaps for each specialty.

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If you click on the specialty name, you will be able to drill into the county listing for the specialty as shown below. From there, you can click on the county name to get to the views described above under View Details by County.

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Data Summaries – in addition to the Network Adequacy review, you will find high level data summaries. Based on the product you are reviewing; you will find data summaries specific to this product. You can click through each item in the left menu to see your overall summary, provider counts by specialty, provider counts by county, and geocode results (how the latitude/longitude coordinates were assigned).

Overall Summary

Providers by Specialty

Providers by County

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Providers by Geocode Results

Geocode Results

Address‐Exact – The record was geocoded at the address level.

Address‐Relaxed ‐ The record was geocoded at the address level, but a component was missing, such as directional prefixes/suffixes or street type.

AddressRelaxed-ZipMismatched – While the record contained a full street address, the Zip Code was invalid or missing. Zip Code Correction replaced this record’s invalid or missing zip code with the correct zip code.

Zip Point – The zip code is a point zip (PO Box, Building, Office, etc.) and the latitude and longitude are assigned based on the specific point in the zip code. An example of a Zip Point would be the Empire State Building, as it has its own zip code.

Zip Distributive – These records could not locate an address and then defaulted to assume a latitude and longitude based on the population patterns of the zip code. Keep in mind that the points plotted are approximate, and are not based upon the actual street address.

Not Geocoded‐Invalid Zip – The zip code is not valid.

Data Validation – Here you will find some additional data inspections on the NPI, Specialty and Address. From any of these views, you can click on the counts to drill into the details.

NPI Inspection

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Address Inspection

Panel Status Inspection

Quest Analytics, L.L.C. 4321 W. College Ave, Suite 300

Appleton, Wisconsin 54914 Office 920.739.4552

Fax 920.739.4902

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Appendix A: Population Distribution Methodology

The Network Adequacy review includes a file of distributive points throughout each county based on population patterns to accurately measure provider access consistently across issuers. When calculating Network Adequacy, the % with and without access is based on the measurement from each of these points within each county. Below is a visual display of these population patterns at the state level as well as a drill down to the 5 counties shown below:

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